It is time to question the boondoggle that is and will be the implementation of the World Health Organization-generated International Classification of Diseases, Eleventh Revision (ICD-11). Once it is likely adopted by the World Health Assembly next May and put into effect in 2022 after the Centers for Disease Control and Prevention (CDC) modify it, it will inevitably wreak havoc on the practice of medicine. But, don’t worry, despite further encumbering patient care, costing a bundle and contributing to physician job dissatisfaction, it will serve its real purpose of being a billing tool that ties medical diagnostic codes for reimbursement - all the while creating and expanding an entire industry of medical coding specialists. This ICD system further enables the Big Data obsession to continue without any assessment of the ultimate price paid.

To understand the burden it creates for physicians to add data entry to their patient care responsibilities, thereby generating another layer of distraction from the patient, consider that in 2015 the CDC along with the Centers for Medicare and Medicaid Services (CMS) initiated a clinically modified version called ICD-10-CM - containing 68,000 diagnostic codes and 87,000 codes for procedures, all to be selected by the physician for the purposes of billing and reimbursement. The previous ICD-9 included roughly 14,000 and 4,000 for procedures.

After a deep dive into the 68,000 codes, I wrote in 2016 about my top ten favorites that underscore the inane nature of the process - no embellishment necessary. Yes, the following are all different codes but are worth repeating. They reflect only a minor sampling, so imagine all of the others not included:

1. If statisticians who make up these codes treated patients, then they would realize paper cuts don’t usually require a follow-up.

W26.2XXA Contact with Edge of Stiff Paper, initial encounter

W26.2XXD Contact with Edge of Stiff Paper, subsequent encounter

2. Please don’t strike or get struck by sports equipment as the mental anguish your provider will face in selecting a code might be too much to bear, and now I am even uncertain if the gym is really safe:

Y08.8 Assault by Strike by Sports Equipment

W18.01 Striking Against Sports Equipment with Subsequent Fall

W21 Striking Against or Struck By Sports Equipment

W218 Striking against or struck by other sports equipment

86349 Striking against or struck by unspecified sports equipment

3. Self-explanatory:

04499 F02 Dementia in other diseases classified elsewhere

04500 F028 Dementia in other diseases classified elsewhere

4. Huh?!

04529 F101 0 Alcohol abuse

04530 F1010 1 Alcohol abuse, uncomplicated

04531 F1012 0 Alcohol abuse with intoxication

04532 F10120 1 Alcohol abuse with intoxication, uncomplicated

04534 F10129 1 Alcohol abuse with intoxication, unspecified

5. Well, this clarifies everything:

22704 N488 0 Other specified disorders of penis

22708 N4889 1 Other specified disorders of penis

22709 N489 1 Disorder of penis, unspecified

6. No part of the body spared when bites are the topic:

34128 S30867 Insect bite (nonvenomous) of anus

34129 S30867A Insect bite (nonvenomous) of anus, initial encounter

34130 S30867D Insect bite (nonvenomous) of anus, subsequent encounter

34131 S30867S Insect bite (nonvenomous) of anus, sequela

7. I could go on endlessly with every permutation. But, your attention span and my fatigue won’t allow it:

8. Here I have to channel my inner zoologist, because in real life patients often do not even know what bit them:

86974 W5621 Bitten by orca

87157 W6111 Bitten by macaw

86886 W5522 Struck by cow

87187 W6133 Pecked by chicken

90025 Y9271 Barn as the place of occurrence of the external cause

W56 Contact with nonvenomous marine animal

W62 Contact with nonvenomous amphibians

9. How is as important as where:

W75 Intentional self-harm by explosive material

W76 Intentional self-harm by smoke, fire and flames

W77 Intentional self-harm by steam, hot vapors and hot objects

89965 Y92253 Opera house as the place of occurrence of the external cause

10. If water sports are your thing…

V9107 Burn due to water-skis on fire

V9422 Rider of non powered watercraft struck by powered watercraft

V944 Injury to barefoot water-skier

In conclusion

ICD-11, like its predecessors, is being pitched as a great data source and a fix to interoperability of electronic medical records. The problem is identifying a code that corresponds with pneumonia acquired from aspirating while fighting an eel during a night-time swim in a lake during a snowstorm (which is already detailed in the doctor’s note) is redundant, cumbersome and a poor use of a health provider’s limited time in the real, not theoretical world of the busy practitioner. Correctly coding does not impact patient diagnosis, treatment or management of disease; instead it co-opts the visit. Health insurers and systems should not be the priority in the exam room or at the hospital bedside. For the purposes of patient well-being, aspiration pneumonia should suffice.

Dr. Jamie Wells, MD, FAAP, is an award-winning Board-Certified physician with over a decade of experience caring for patients and the Director of Medicine at the American Council on Science and Health. She served as a Clinical Instructor/Attending at NYU Langone, Mt. Sinai-Beth Israel and St. Vincent's Medical Centers in Manhattan. Dr. Wells graduated from Yale University with honors, was inducted as a junior and elected President of Jefferson Medical College's Alpha Omega Alpha National Medical Honor Society and has been named a New York Super Doctor, repeatedly, in the NY Times magazine supplement listing the top 5% of physicians in over 30 medical specialties as chosen by their peers.
A National Merit Scholar, Dr. Wells was identified for her academic excellence early on when she was selected by the Center for Excellence in Education (CEE) for its prestigious Research Science Institute (RSI) and was featured as one of the top twenty high school students in the nation in USA TODAY as a recipient of their scholarship. At Yale, she was President of the Yale Science and Engineering Association, majored in American Studies and concentrated in media and film, spending her final year researching her senior essay entitled, "Ebola: The Making of an Epidemic"-- exploring the power of the governmental, political, public health and media machines and their desire to work in harmony when there is a common economic concern. In medical school, she maintained various leadership and elected positions (such as Editorials Editor of the school paper and editing guides to passing Board Exams) while creating mentoring and tutoring programs and spearheading countless volunteer activities that served the school and local Philadelphia communities. During this time, she did research for the Department of Neurosurgery at the University of Pennsylvania School of Medicine in deep brain stimulation of the subthalamic nucleus of patients with Essential Tremor and Parkinson's Disease.
She was a grant reviewer for Komen's 2018-2019 Community Grants Program and has judged the local, district and world championships for Dean Kamen’s F.I.R.S.T. (For Inspiration & Recognition of Science & Technology) robotics competition as well as the Miss America’s Outstanding Teen scholarship competition for which she was recently nominated and, subsequently, elected to be a member of its Board of Directors. Dr. Wells is on the Leadership Council of The Wistar Institute (the nation's first independent biomedical research facility and certified cancer center) and is a Visiting Fellow at the Independent Women's Forum. She has been awarded America's Top Pediatricians, America’s Top Physicians Honors of Distinction and Excellence, Compassionate Doctors Award, Patients Choice Award (honors given by patients to less than 3% of the nation's 720,000 active physicians) and been recognized for her exemplary care of those with Cystic Fibrosis. Dr. Wells was named a Doctor of Excellence which profiles the world’s leading doctors who have demonstrated success and leadership in their profession. For the better part of a decade, she answered all of the medical inquiries on line for the Boomer Esiason Cystic Fibrosis Foundation's website in a section entitled, ASK DR. WELLS.
Whether she is published, for example, in the acclaimed journal Neoreviews for a case involving a near drowning of an infant via water birth, USA Today regarding the mysterious illness of US diplomats in Cuba or the Huffington Post in response to the Dolce & Gabbana controversy or 10 ways to Save Your Life or the Life of a Loved One, it is a longstanding passion of hers to make science and health understanding accessible to all. She champions empowering others to be their own advocate in healthcare and has given talks to various audiences from struggling expectant mothers and parenting groups to undergraduates, spoken on panels as well as emphasized education to patients under her care. Believing she wanted to be a brain surgeon, she began her first residency in neurosurgery, ultimately switching fields to pediatrics. As a result, her knowledge is vast in the medical realm and sought after by innumerable media outlets.
Dr. Wells’ greatest asset is making complicated material palatable for people in a nonthreatening, often humorous way. Her opinion as a medical expert has been showcased on live and taped local, national and international television programs that run the gamut from CNN, Fox National News Channel, ABC News, BBC, Reuters, Al Jazeera TV, NY 1, CBS, TLC, Fox Business Network, Fox 5, Parent TV, CUNY-TV, My 9, Arise TV and so on having been featured in an hour length show on Discovery Health and, repeatedly, on Sirius Radio for Martha Stewart Living. She is a huge proponent of the health benefits of animals and was certified with her adorable and gifted English Bulldog, Mollie Joe, as a therapy team.
We asked New York City to guess her profession and no one got it right:

We are funded mostly by readers like you. Please consider donating!

"Big Fears Little Risks" is a documentary, but unlike most of what you see on places like Netflix, it is pro-science, and not scaremongering trace chemicals, food, or the modern world. We instead are going to take back the discourse from trial lawyers and the trade groups they use to profit from fear.

The American Council on Science and Health is a research and education organization operating under Section 501(c)(3) of the Internal Revenue Code. Contributions are fully tax-deductible. ACSH does not accept government grants or contracts, nor do we have an endowment. We raise our funds each year primarily from individuals and foundations.